1. PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  Custer
Inc Town:  
City:  
No.  
St.  
Ward:  
Registration District No.:  5315
Primary Registration District No:  
File No.  17200
Registered No:  
2. FULL NAME:  Lyon, Sophia Ann
PERSONAL AND STATICAL PARTICULARS
3. SEX:  Female	
4. COLOR OR RACE:  White
5. SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Widowed
6. DATE OF BIRTH:  Sept. 13, 1827
7. AGE  (yr. mo. da) (If less than 1 day, hours or min?):  83 yr 10 mo 13 da
8. OCCUPATION (a.) Trade, profession or particular kind of work:  Housework
(b.)  General nature of industry business or establishment which employed:  
9. BIRTHPLACE:  Simson Co., TN
10. NAME OF FATHER:  Moses Scott
11. BIRTHPLACE OF FATHER:  VA
12. MAIDEN NAME OF MOTHER:  Rachel Hardy
13. BIRTHPLACE OF MOTHER:  VA
14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Cleveland Allen
(Address)  Custer, KY
15. Filed  July 28, 1911
REGISTAR:  R. O. Penick
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  July 26, 1911
17. I HEREBY CERTIFY, That I attended deceased from (date):  July 13, 1911
That I last saw him/her alive on (date):  July 22, 1911
And that death occurred on the date stated above at (time AM/PM):  9 PM
THE CAUSE OF DEATH was as follows:  Anemia

(Duration)   Years:    1	   Months:   10         Days:  26
Contributory:  Old age

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  J. W. Meador
Date:  
Address:  Custer, KY
18. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  
Former or usual residence:  
19. PLACE OF BURIAL OR REMOVAL:  Lyon Cemetery
DATE OF BURIAL:  
20. UNDERTAKER:  R. B. Lockhart
ADDRESS:  Custer, KY